Title: The effectiveness of superpulsed CO2laserin the treatment of ingrown nail deformities.

Authors: Tada Hideyuki, MD, PhD, Hatoko Mitsuo, MD, PhD,

Madhya Kumis, MD, Tanaka Aya, MD, Iioka Hiroshi, MD,

Niitsuma Katsunori, MD

In a daily clinic, we often encounter the ingrown nail deformities. Various surgical procedures have been reported for correcting these deformities1, 2.However, these procedures often cause a postoperative severe pain and a long wound-healing time. In this study, we use the super pulsed CO2 laser3, 4 for the treatment of ingrown nail and evaluate the results.

Materials and Methods: Twenty-five patients with ingrown nail deformity of the great toe were treated with super pulsed CO2 laser system added to the scanning function (Fig.1). The postoperative follow-up period ranged from 8 to 20 months. Ten patients had been previously treated with partial or total nail avulsion.

After the digital nerve block with 1% lidocaine solution without containing epinephrine, a linear incision is made on the nail plate and nail root about 2mm from the invagination with scissors. Then the affected nail is pulled out gently not to damage the nail bed and lateral nail groove. Following the partial nail avulsion, the affected nail matrixand proximal nail fold is vaporized using the superpulsed CO2 laser. Then, the nail matrix is vaporized sufficiently to the extent that the periosteum of distal phalanx is exposed using CO2 laser. Raw surface occurred by the vaporization is not sutured. The ointment gauze is placed into the space of the vaporized nail matrix.

Case Report: A 42-year-old man had a severe pain in the left great toe. The medial side of the nail was incurved and this condition caused the inflammation and infection of lateral nail groove. (Fig.1a) After the infection was cured by conservative treatment, the vaporization of nail matrix using superpulsed CO2 laser was performed. (Fig.1b) This patient could go to work on the next day after the surgery and surgical wound was closed on the 7th days after the surgery. Postoperative complication, such as infection or scarring, was not observed during the follow-up period. Furthermore, there was no recurrence of ingrown nail deformity at the 10th month after the surgery. (Fig.1c)

Results: In all cases, the operative wounds were closed spontaneously within 10days after the operation and no postoperative complications, such as infection or bleeding was observed. The mean operating time was fifteen minutes. The follow-up period ranged from 8 to 20 months. Of 25 cases, 22 cases showed no recurrent nail spike during the follow-up period.The rest 3 cases showed the re-growth of the nail within the sixth postoperative month. The cure rate was 88%. All the patients could return to their daily activity on the three days after the surgery without any problem. The severe scarring was not observed in the follow-up period.

Conclusion: In this study, we treated the ingrown nail with the superpulsed CO2 laser system. Consequently, we could vaporize the nail matrix without any damage to periosteum of distal phalanx. According to these characters, we used the focused beam for incision of proximal nail fold, and defocused beam for the vaporization of nail matrix. From our experience, we assumed that there were following many benefits in our procedure.

Operation time was short (mean: 12minutes) and postoperative bleeding was almost none, the postoperative pain was mild and reduced within 2days,patients could care their operative wound by themselves. These enabled the patients to return to their daily activity within the three days after the operation. Furthermore, the operative wounds were closed spontaneously within ten days after the operationwithout significant scarring.Cure rate is comparatively high.

In conclusion, the use of superpulsed CO2 laser could achieve the satisfied results for the treatment of ingrown nail deformities, because of less postoperative complication,early return to daily life, and high cure rate.

Fig. 1a Fig. 1b Fig. 1c

Figure Legends

Fig. 1a: preoperative view of left great toe

Fig. 1b: intraoperative view after the vaporization of lateral

nail groove and nail matrix using the superpulsed CO2

laser

Fig. 1c: postoperative view in the 10th month after the surgery

References

1.Murray, W.R., Bedi, B.S. The surgical management of ingrowing toenail. Br J Surg 62: 409-412, 1975.

2.Umeda T., Nishioka K., Ohara K. Ingrown nails: an evaluation of elevating the nail bed-periosteal flap. J Dermatol 19: 400-403, 1992.

3.Fitzpatrick, R.E., Ruiz-Esparza, J., Goldman, M.P. The depth of thermal necrosis using the CO2 laser: a comparison of the superpulsed mode and conventional mode. J Dermatol Surg 17:340-344, 1991.

4.Fitzpatrick, R.E., Goldman, M.P., Ruiz-Esparza, J. Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratosis, lentigines, and actinic cheilitis. J Dermatol Surg 20: 449-456, 1994.